The 107 page independent review has been written by Brian Donnelly, and presents a strong case for National Minimum Standards by exposing the seriousness of potential breaches in legislation. Within his analysis he covers in detail new legislation such as The Health and Safety (Offences) Act 2008 and the UN Convention on the Rights of Persons with Disabilities.

THIIS has been in discussion with Brian over this issue after meeting him at various Community Equipment events. Brian is well positioned to release this document, having worked with CES at both local and national levels. He has worked directly within and supported approximately 15 community equipment services (CES) throughout England and Wales over the past 8 years. Some of his roles have included: Project Manager; Service Manager; Consultant; Head of Service & Development, and most recently, National Development Officer for CES, within the Welsh Assembly Government.

He has brought several unique initiatives to CES over the years. For example, he was first to introduce the Just-In-Time (JIT) stock replenishment concept to CES in 2002/3, and in 2004 he introduced a countywide multi-agency children's equipment service in Buckinghamshire, which was the first service of this kind in the UK. He has also proposed a unique initiative in Wales to introduce a national all-sector service to deal with specialist, complex and children's equipment, which is currently underway.

Brian is keen to emphasise that National Minimum Standards would not conflict with any method of service provision, but would ensure consistent, high quality services across the country, regardless of method of provision or future developments. He told us; “The National Minimum Standards document is not intended to undermine the excellent work in some services, nor some of the initiatives currently being looked at. It is hoped that a healthy debate is stimulated as a result of the document with the ultimate view that all services and initiatives are established upon a robust foundation of quality and safety.”

The comprehensive document has been given forewords from both Sir Bert Massie CBE, and Michael Mandelstam MSc.

Sir Bert Massie calls the report “a clarion call for Community Equipment Services to be adequately funded.” He states: “Unfortunately, many people within government and elsewhere still fail to appreciate that the right equipment supplied at the right time can be hugely cost-effective. This report illustrates the financial implications of that folly. The wrong wheelchair might well save a few pounds but can cause such damage to the user that the health service and then social services incur bills of tens of thousands of pounds.”

Michael Mandelstam comments that ICES and TCES “…fall short in at least two fundamental respects. First, they are generally silent about safety and risk which, as Brian Donnelly points out, are very real issues. Second, they are equally and notably silent about people's legal entitlement to equipment provision from local authorities and the NHS.” He adds “Talk of choice, and of high quality equipment provision, is empty if not premised on basic safety and on statutory entitlement. Without a solid foundation, a policy of choice is specious and could lead even to an erosion of people's safety and welfare.” He sums up the document by saying it is “…timely and admirably to the point. It is to be commended.”

In the document Brian has:

• Clearly set out the legal and welfare parameters CES operate within, and points to potential breaches.
• Highlighted serious breaches in health and safety, and medical device management, and identified where indeed the law may be being broken.
• Identified serious risks and quality related issues with current and proposed initiatives.
• Demonstrated that CES are not currently subject to any robust inspection or regulation regime.
• Pointed to huge unnecessary health and social care costs (Billions) incurred by not giving CES due care and attention.
• Pointed to clear policy objectives not being met, with little or no means for determining how services align with these.
• Pointed to weaknesses in Commissioning, Governance and Eligibility Criteria – areas not addressed to date.
• Highlighted the appalling service given to people with Complex, Specialist or Children's equipment needs.
• Highlighted that some new and proposed initiatives e.g. Transforming Community Equipment Services (TCES), could create more problems than they aim to solve, if not founded upon appropriate standards.

The document recommends that a concordat arrangement is set up between the different regulatory bodies e.g. Health & Safety Executive, Medicines and Healthcare products Regulatory Agency (MHRA), Care and Social Services Inspectorate Wales (CSSIW) and Care Quality Commission (CQC), with a view to establishing universal standards, and perhaps regulating and inspecting services.

The essence of the NMS document can be summed up by some closing words found in the conclusion of the document: “It is hardly believable that such a critical service has no robust measures in place for ensuring an acceptable level of performance, quality and safety is maintained, given that this is such a high risk environment. The absence of such measures is unnecessarily impacting upon clients, organisations, and the welfare economy as a whole.”

According to the author, the document has been sent to the Welsh Assembly Government, the Care Quality Commission, and the Department of Health and all have responded.

Brian told us; “The Welsh Assembly Government has welcomed the document, and recognises the importance of the issues and concerns raised. They are very interested in National Minimum Standards for Community Equipment Services and are now seeking approval to proceed with their development.”

He added that the Care Quality Commission (CQC) also acknowledged the importance of the document, and was thankful for bringing the issue to their attention. “CQC are aiming to develop ‘guidance about compliance' early summer 2009, which will hope to cover community equipment services. It is intended for there to be a consultation on this, and it will be open for all to participate. CQC Chief Executive, Ms Cynthia Bower, said if any detailed work takes place in this service area they would be pleased to utilize the information in the report, as appropriate.”

According to Brian, the response from the Department of Health focused on the Transforming Community Equipment Services (TCES) initiative. “The response alluded to the Community Equipment Dispensing Accreditation Body (CEDAB), which basically focuses on the ‘retailer'. The response failed to recognise the much wider issues outside the retailer e.g. commissioning, legal and welfare requirements, and the specialist and complex equipment issues. It also failed to mention that, relatively speaking, there are very few services currently working with the TCES model, and therefore most services would not be subject to the CEDAB regulations anyway.”

The document has also been recently sent to the National Association of Equipment Providers (NAEP) Council, the College of Occupational Therapists (England & Wales), Health & Safety Executive (HSE), and Medicines and Healthcare products Regulatory Agency (MHRA). Brian intends to eventually send the document to all relevant organisations e.g. voluntary sector.

Brian has said within the document that, “…although this review is focussed specifically upon community equipment services, the principles within the document also apply to most other community based equipment providers throughout England and Wales e.g. wheelchair services.”